Intended for healthcare professionals

Editor's Choice

The power of women, community, and Bob Geldof

BMJ 2004; 329 doi: (Published 11 November 2004) Cite this as: BMJ 2004;329:0-h
  1. Kamran Abbasi (kabbasi{at}, acting editor

    Twenty years ago images of Ethiopia were beamed into our living rooms and showed people in poor countries living with overwhelming poverty, disease, and despair. What could they possibly teach us? At least we could offer money, pity, and our clever ideas about eradicating corruption and resurrecting their failed states. When musician Bob Geldof inspired his pop pals to sing for charity we learnt that one man could begin to change the world, provided that man lived in a rich country. “Do they know it's Christmas?” may have been a futile lyric for millions living in poverty, but it captured a mood that said we are no longer willing to tolerate such a divided world.

    Now, with a humanitarian crisis in Sudan, sub-Saharan Africa in deep poverty, Asia strangled by child deaths, and Bob Geldof singing his Christmas song again, what have we really learnt and what have we done for the world's poor? Perhaps there are better ways of lifting Africa and Asia out of poverty? Perhaps there are local solutions that—since they work in the most desperate circumstances—might even teach us, the privileged in richer countries, better ways of improving our health care. Why look to the United States for ideas when you might equally adopt pioneering initiatives from Bangladesh (p 1124), Colombia, India, Iran (p 1115, p 1134), Haiti (p 1142), Malawi (p 1164), Pakistan, Tanzania (p 1126), or Zimbabwe?

    This is the premise of our theme issue, a celebration of the ingenuity of the human spirit brought to you by Tessa Richards and her team of international advisers (p 1113), who argue that the rich world doesn't have a monopoly on solutions. And there is much to learn, particularly that it will take many millions of women in poor countries to change the world. For states to free themselves of poverty, women's health, education, and employment have to be priorities—another message that has been sung loudly for decades. But what has been the response? Women have become effective agents of change in maternal and child health in the poorest communities (p 1117, p 1166), initiatives for prevention of mother to child transmission are successfully implemented (p 1147), “positive deviance” is a powerful way of promoting beneficial healthcare behaviour (p 1177), and Kangaroo Mother Care, whereby low birthweight infants use their mothers—or fathers—as incubators, can create ideal conditions for infants to thrive (p 1179). A stepdown unit, which involves mothers in the regular care of stable, low birthweight infants, reduces hospital stay (p 1151).

    Alongside the power of women we are reminded of the power of community. “As the power of systems grows, the power of community declines, and as control magnifies, consent fades,” say Masamine Jimba and Susumu Wakai (p 1183). “As standardisation is implemented, creativity disappears—to build a healthful society both system and community are needed.” Amen.


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